| NPI | 1619328499 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A197590) | 
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MO 2016020262) | 
| 207Y00000X Otolaryngology (Licence: PA MD481433) | |
| Enumeration Date | 2016-06-23 | 
| Last Update Date | 2024-10-11 |